Dana L. Yeoman, DDS
Dentures and Implants
Just Because it Doesn’t Hurt... | Dana L. Yeoman, DDS
Site last published: 08/21/10
Just Because it Doesn’t Hurt...
09/08/08 17:44
A 96
year old man named Harold came into the office
needing help with his full upper denture and lower
partial. He had just a few teeth left in the front
part of his lower jaw, and the partial denture hung
very precariously onto faltering teeth. He had the
obvious problems that he could tell me about, like
a broken tooth, a badly fitting denture and denture
teeth that do not meet up correctly in the back.
Looking in his mouth, I could see a bigger problem
that he did not know about. He only knew about the
tip of the iceberg.
Just
Because it Doesn’t Hurt...
A 96 year old man named Harold came into the office needing help with his full upper denture and lower partial. He had just a few teeth left in the front part of his lower jaw, and the partial denture hung very precariously onto faltering teeth. He had the obvious problems that he could tell me about, like a broken tooth, a badly fitting denture and denture teeth that do not meet up correctly in the back. Looking in his mouth, I could see a bigger problem that he did not know about. He only knew about the tip of the iceberg.
The chewing teeth on the part of the partial that rests on the soft tissue were significantly shorter than the natural teeth in front, attesting to severe bone loss in back since his molars were extracted. This situation had been aggravated by the natural teeth growing taller as the partial tipped further and further down. Since the back teeth could not meet up anymore, Harold had been using his front teeth to chew like a rabbit. The front part of the upper denture was overloaded, beating the upper gums up until the bone went away. The tissue that used to be a solid, firm footing to hold a denture in place had become spongy and jello- like, making the front teeth appear to bounce when he chewed. His chin and nose were closing in on each other. Meanwhile, the bony tissue in the back of his palate had grown unnaturally downward. Between the sunken front and the elongated back, his upper denture looked like it was frowning, the back teeth showing more than the front. This gave Harold a permanent scowl, even when he was in a good mood. Yes, the dentures did not fit, but as you can see, that was the least of his problems.
This cocktail of symptoms mixes into the classical condition called Combination Syndrome, first described in an article in 1972 by Dr. Ellsworth Kelly, a UCSF professor. Dr. Kelly used the term “Combination” because the lower partial is supported half on the teeth and half on the tissue. When the tissue support is lost, the symptoms show up. Since I started writing this article, I have seen at least one case as extreme as Harold’s per week. (You know who you are because I have told you that I am writing this article for you.)
Harold will always have problems. There is no surgery adequate to replace the destroyed bone so that he can wear a denture without problems. 60% of all the bone grafted in surgery will dissolve away within the first year. Sometimes the surgeon will cut off the flabby tissue, but that can reduce any suction the denture might have otherwise had. With so little bone, even implants would require extensive reconstructive surgery and still have a high failure rate. There is no miracle cure for the damage already done. Denture wearers who only go to the dentist when it hurts are most subject to this kind of irreversible damage. The only way to totally avoid this dilemma is to have never allowed this situation in the first place. This means, protect your most precious resource, your bone!
If you have an upper denture against a lower partial, visit your dentist every year to check on the condition of your mouth. Plan to replace your prostheses every 3 to 6 years. That may sound like a lot, but remember, there is no going back. I have seen Combination Syndrome in 40 year olds. How will it look in 20 more years? A 96 year old might overlook the fact that his front teeth bounce up and down when talking, but picture yourself meeting your son’s new fiance, or convincing a potential customer to buy your product. Far worse than any of these is when your 4 year old grandson asks why your teeth move so funny.
There is some good news to be had. I was able to make Harold a new set of dentures that would stop destroying his mouth. Part of the solution was to move all the chewing capacity to the back teeth where the footing was solid. According to an article on treating Combination Syndrome by William S. Jameson, D.D.S. in 2001, the front teeth are to be used only for helping you speak properly and for smiling only. The front teeth should never touch, especially for chewing and biting. Customizing for proper retention will keep his upper denture from falling out, even if the front teeth still wiggles slightly when he touches his teeth together. Harold will get by, but just barely.
Let his story be a wake up call for you. Protect yourself and get checked by a dentist before your symptoms get any worse. Call me with any questions, and see what can be done for you Just Because it Doesn’t Hurt...
Dana L. Yeoman, D.D.S.
Second Smile Denture Care
3301 19th Street
Bakersfield, CA 93301
Tel: 661-325-1263
A 96 year old man named Harold came into the office needing help with his full upper denture and lower partial. He had just a few teeth left in the front part of his lower jaw, and the partial denture hung very precariously onto faltering teeth. He had the obvious problems that he could tell me about, like a broken tooth, a badly fitting denture and denture teeth that do not meet up correctly in the back. Looking in his mouth, I could see a bigger problem that he did not know about. He only knew about the tip of the iceberg.
The chewing teeth on the part of the partial that rests on the soft tissue were significantly shorter than the natural teeth in front, attesting to severe bone loss in back since his molars were extracted. This situation had been aggravated by the natural teeth growing taller as the partial tipped further and further down. Since the back teeth could not meet up anymore, Harold had been using his front teeth to chew like a rabbit. The front part of the upper denture was overloaded, beating the upper gums up until the bone went away. The tissue that used to be a solid, firm footing to hold a denture in place had become spongy and jello- like, making the front teeth appear to bounce when he chewed. His chin and nose were closing in on each other. Meanwhile, the bony tissue in the back of his palate had grown unnaturally downward. Between the sunken front and the elongated back, his upper denture looked like it was frowning, the back teeth showing more than the front. This gave Harold a permanent scowl, even when he was in a good mood. Yes, the dentures did not fit, but as you can see, that was the least of his problems.
This cocktail of symptoms mixes into the classical condition called Combination Syndrome, first described in an article in 1972 by Dr. Ellsworth Kelly, a UCSF professor. Dr. Kelly used the term “Combination” because the lower partial is supported half on the teeth and half on the tissue. When the tissue support is lost, the symptoms show up. Since I started writing this article, I have seen at least one case as extreme as Harold’s per week. (You know who you are because I have told you that I am writing this article for you.)
Harold will always have problems. There is no surgery adequate to replace the destroyed bone so that he can wear a denture without problems. 60% of all the bone grafted in surgery will dissolve away within the first year. Sometimes the surgeon will cut off the flabby tissue, but that can reduce any suction the denture might have otherwise had. With so little bone, even implants would require extensive reconstructive surgery and still have a high failure rate. There is no miracle cure for the damage already done. Denture wearers who only go to the dentist when it hurts are most subject to this kind of irreversible damage. The only way to totally avoid this dilemma is to have never allowed this situation in the first place. This means, protect your most precious resource, your bone!
If you have an upper denture against a lower partial, visit your dentist every year to check on the condition of your mouth. Plan to replace your prostheses every 3 to 6 years. That may sound like a lot, but remember, there is no going back. I have seen Combination Syndrome in 40 year olds. How will it look in 20 more years? A 96 year old might overlook the fact that his front teeth bounce up and down when talking, but picture yourself meeting your son’s new fiance, or convincing a potential customer to buy your product. Far worse than any of these is when your 4 year old grandson asks why your teeth move so funny.
There is some good news to be had. I was able to make Harold a new set of dentures that would stop destroying his mouth. Part of the solution was to move all the chewing capacity to the back teeth where the footing was solid. According to an article on treating Combination Syndrome by William S. Jameson, D.D.S. in 2001, the front teeth are to be used only for helping you speak properly and for smiling only. The front teeth should never touch, especially for chewing and biting. Customizing for proper retention will keep his upper denture from falling out, even if the front teeth still wiggles slightly when he touches his teeth together. Harold will get by, but just barely.
Let his story be a wake up call for you. Protect yourself and get checked by a dentist before your symptoms get any worse. Call me with any questions, and see what can be done for you Just Because it Doesn’t Hurt...
Dana L. Yeoman, D.D.S.
Second Smile Denture Care
3301 19th Street
Bakersfield, CA 93301
Tel: 661-325-1263